Provider Demographics
NPI:1508413659
Name:KELLY, TIFFANY (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CONFERENCE DR STE 4139
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1933
Mailing Address - Country:US
Mailing Address - Phone:615-285-9614
Mailing Address - Fax:
Practice Address - Street 1:919 CONFERENCE DR STE 4139
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1933
Practice Address - Country:US
Practice Address - Phone:615-285-9614
Practice Address - Fax:615-694-5367
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst